THIRD MOLAR EXTRACTION PAIN, OEDEMA, AND TRISMUS PREVENTION REGIMES COMPARED ACCORDING TO TYPE, DOSAGE, AND ADMINISTRATION METHOD OF CORTICOSTEROIDS: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.33279/jkcd.v16i02.1013Keywords:
Administration, Oral; Adrenal Cortex Hormones; Dexamethasone; Edema; InjectionsAbstract
Objectives: To compare the effectiveness of various corticosteroid regimens (type, dose, and route) in preventing pain, swelling, and trismus following third molar surgery.
Materials and Methods: A systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science and the Cochrane Library until December 2025. Randomized controlled trials (RCTs) comparing any corticosteroid regimen to placebo or another active regimen were included. 15 RCTs (1,342 procedures) met eligibility criteria. Information about pain (Visual Analogue Scale), swelling, and trismus was gathered. Researchers conducted systematic reviews using random-effects models and the Cochrane RoB2 tool to assess risk of bias.
Results: Corticosteroids had a significant effect on swelling and trismus compared with placebo, but a moderate impact on pain. Oral dexamethasone (8mg) was not inferior to intramuscular administration of swelling (72h Mean Difference (MD): 0.6mm, 95% Confidence Interval (CI): -0.5 to 1.7). An 8 mg dose was superior to a 4 mg dose of Dexamethasone. The submucosal route had a meaningful benefi t compared with oral, producing less trismus (48h MD: 3.2mm, 95% CI: 1.1 to 5.3).
Conclusion: Methylprednisolone and dexamethasone were similar. There were no severe adverse incidents. Dexamethasone (8 mg) was an effective oral standard treatment. The submucosal route is also a worthy alternative, with particular advantages in cases of trismus. The choice of regimen may be determined according to clinical requirements, and all steroids are used as a supplement to the primary analgesia.
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